865 resultados para Optimal combinations


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Introducción: A pesar de que las combinaciones de Propofol y opioides son ampliamente usadas para inducir y mantener una adecuada anestesia y analgesia, disminuir la dosis del inductor, incrementar la estabilidad hemodinámica y suprimir la respuesta a la laringoscopia y la intubación; no existen estudios que comparen el uso de Anestesia Total Intravenosa manual con Remifentanil - Propofol versus Fentanil - Propofol. Objetivo: Comparar el tiempo de despertar y el tiempo de descarga entre dos técnicas de Anestesia Total Intravenosa manual empleadas en el Hospital Occidente de Kennedy, una basada en Propofol y Remifentanil y otra basada en Propofol y Fentanil controlado por Stangraf. Metodología: Estudio de corte transversal, en 43 pacientes llevados a cirugía bajo Anestesia Total Intravenosa en el Hospital Occidente de Kennedy. Se analizó la información mediante las pruebas de Shapiro-Wilks, t de Student y U de Mann Withney y los coeficientes de correlación de Spearman y de Pearson, usando SPSS versión 20 para Windows. Un valor de p < 0.05 fue aceptado como estadísticamente significativo. Resultados: Al comparar las dos técnicas, no se encontraron diferencias estadísticamente significativas en los tiempos evaluados. El tiempo de despertar promedio fue 10,1 minutos para Fentanil y 10,2 minutos para Remifentanil. El tiempo de descarga para Fentanil fue 11,9 minutos y para Remifentanil fue 11,5 minutos. Conclusiones: El uso de Fentanil - Propofol guiado por Stangraf es equivalente al uso de Remifentanil – Propofol en cuanto a los tiempos de despertar y de descarga. Se requieren nuevos estudios para corroborar estos hallazgos.

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Introducción: La anestesia total intravenosa (TIVA) es ampliamente usada y reportada en la literatura como técnica para disminuir la respuesta a la laringoscopia e intubación, en la inducción y mantenimiento de una adecuada anestesia, además de una mejor estabilidad hemodinámica y recuperación pos anestésica; sin embargo no existen un gran número de estudios que comparen el uso de TIVA, determinando si existen diferencias en el perfil farmacocinético según el género del paciente. Objetivo: Describir diferencias farmacocinéticas y de los tiempos de despertar y salida a la unidad de cuidados pos anestésicos (descarga), según el género; en pacientes que reciben TIVA, con remifentanil y propofol, orientado por Stangraf. Metodología: Estudio observacional analítico de corte transversal, en pacientes llevados a cirugía bajo TIVA en el Hospital Occidente de Kennedy en el periodo de junio de 2013 a Enero de 2014.Usando SPSS versión 20 Windows, se analizaron los datos mediante pruebas Kolmogorov-Smirnov y Shapiro-Wilk y U de Mann Withney. Un valor de p menor 0.05 fue aceptado como estadísticamente significativo. Resultados: Se aplicaron pruebas de normalidad y no se encontraron diferencias estadísticamente significativas entre género. El tiempo de despertar fue 9.36 minutos para mujeres y 11.26 minutos para hombres. Los tiempos de descarga fueron 10.71 minutos para mujeres y 12.82 minutos para hombres. Discusión. El tiempo de despertar y descarga no es diferente entre mujeres y hombres en los pacientes analizados. Se requieren estudios adicionales entre grupos poblacionales de diversas condiciones farmacocineticas para corroborar los datos.

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The optimal combination of the mechanical characteristics of austempered spheroidal graphitic cast steel together with modern casting techniques yielded an economically promising product. The maximum potential of the usage of these steels is related to fabrication and characterization techniques, among which, one of the most important is the cooling diagram (TTT curve). In this work, 3 heats of graphitic steels with the following nominal compositions were cast: 1.0 % C, 2.3 % Si, 0.4 % Mn, and with niobium contents of. 0.0 %, 0.5 % and 1.0 %. TTT curves were determined by dilatometric testing and test specimens of these steels were austempered. The samples were then characterized by hardness testing and optical and SEM microscopy. Tensile, impact (no notch) and wear testing were also performed. The addition of niobium produced significant alterations in the TTT diagrams. Increasing niobium content moves the pearlite transformation nose to the right and the bainitic transformation nose to the left. Tensile strength of these alloys was high, in the range of 1700 MPa and impact values were around of 45 Joules for alloy with 1 % Nb, 49 Joules for alloy with 0.5 % Nb and fracture did not occur for the alloy without the addition of Nb.

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In the last years of research, I focused my studies on different physiological problems. Together with my supervisors, I developed/improved different mathematical models in order to create valid tools useful for a better understanding of important clinical issues. The aim of all this work is to develop tools for learning and understanding cardiac and cerebrovascular physiology as well as pathology, generating research questions and developing clinical decision support systems useful for intensive care unit patients. I. ICP-model Designed for Medical Education We developed a comprehensive cerebral blood flow and intracranial pressure model to simulate and study the complex interactions in cerebrovascular dynamics caused by multiple simultaneous alterations, including normal and abnormal functional states of auto-regulation of the brain. Individual published equations (derived from prior animal and human studies) were implemented into a comprehensive simulation program. Included in the normal physiological modelling was: intracranial pressure, cerebral blood flow, blood pressure, and carbon dioxide (CO2) partial pressure. We also added external and pathological perturbations, such as head up position and intracranial haemorrhage. The model performed clinically realistically given inputs of published traumatized patients, and cases encountered by clinicians. The pulsatile nature of the output graphics was easy for clinicians to interpret. The manoeuvres simulated include changes of basic physiological inputs (e.g. blood pressure, central venous pressure, CO2 tension, head up position, and respiratory effects on vascular pressures) as well as pathological inputs (e.g. acute intracranial bleeding, and obstruction of cerebrospinal outflow). Based on the results, we believe the model would be useful to teach complex relationships of brain haemodynamics and study clinical research questions such as the optimal head-up position, the effects of intracranial haemorrhage on cerebral haemodynamics, as well as the best CO2 concentration to reach the optimal compromise between intracranial pressure and perfusion. We believe this model would be useful for both beginners and advanced learners. It could be used by practicing clinicians to model individual patients (entering the effects of needed clinical manipulations, and then running the model to test for optimal combinations of therapeutic manoeuvres). II. A Heterogeneous Cerebrovascular Mathematical Model Cerebrovascular pathologies are extremely complex, due to the multitude of factors acting simultaneously on cerebral haemodynamics. In this work, the mathematical model of cerebral haemodynamics and intracranial pressure dynamics, described in the point I, is extended to account for heterogeneity in cerebral blood flow. The model includes the Circle of Willis, six regional districts independently regulated by autoregulation and CO2 reactivity, distal cortical anastomoses, venous circulation, the cerebrospinal fluid circulation, and the intracranial pressure-volume relationship. Results agree with data in the literature and highlight the existence of a monotonic relationship between transient hyperemic response and the autoregulation gain. During unilateral internal carotid artery stenosis, local blood flow regulation is progressively lost in the ipsilateral territory with the presence of a steal phenomenon, while the anterior communicating artery plays the major role to redistribute the available blood flow. Conversely, distal collateral circulation plays a major role during unilateral occlusion of the middle cerebral artery. In conclusion, the model is able to reproduce several different pathological conditions characterized by heterogeneity in cerebrovascular haemodynamics and can not only explain generalized results in terms of physiological mechanisms involved, but also, by individualizing parameters, may represent a valuable tool to help with difficult clinical decisions. III. Effect of Cushing Response on Systemic Arterial Pressure. During cerebral hypoxic conditions, the sympathetic system causes an increase in arterial pressure (Cushing response), creating a link between the cerebral and the systemic circulation. This work investigates the complex relationships among cerebrovascular dynamics, intracranial pressure, Cushing response, and short-term systemic regulation, during plateau waves, by means of an original mathematical model. The model incorporates the pulsating heart, the pulmonary circulation and the systemic circulation, with an accurate description of the cerebral circulation and the intracranial pressure dynamics (same model as in the first paragraph). Various regulatory mechanisms are included: cerebral autoregulation, local blood flow control by oxygen (O2) and/or CO2 changes, sympathetic and vagal regulation of cardiovascular parameters by several reflex mechanisms (chemoreceptors, lung-stretch receptors, baroreceptors). The Cushing response has been described assuming a dramatic increase in sympathetic activity to vessels during a fall in brain O2 delivery. With this assumption, the model is able to simulate the cardiovascular effects experimentally observed when intracranial pressure is artificially elevated and maintained at constant level (arterial pressure increase and bradicardia). According to the model, these effects arise from the interaction between the Cushing response and the baroreflex response (secondary to arterial pressure increase). Then, patients with severe head injury have been simulated by reducing intracranial compliance and cerebrospinal fluid reabsorption. With these changes, oscillations with plateau waves developed. In these conditions, model results indicate that the Cushing response may have both positive effects, reducing the duration of the plateau phase via an increase in cerebral perfusion pressure, and negative effects, increasing the intracranial pressure plateau level, with a risk of greater compression of the cerebral vessels. This model may be of value to assist clinicians in finding the balance between clinical benefits of the Cushing response and its shortcomings. IV. Comprehensive Cardiopulmonary Simulation Model for the Analysis of Hypercapnic Respiratory Failure We developed a new comprehensive cardiopulmonary model that takes into account the mutual interactions between the cardiovascular and the respiratory systems along with their short-term regulatory mechanisms. The model includes the heart, systemic and pulmonary circulations, lung mechanics, gas exchange and transport equations, and cardio-ventilatory control. Results show good agreement with published patient data in case of normoxic and hyperoxic hypercapnia simulations. In particular, simulations predict a moderate increase in mean systemic arterial pressure and heart rate, with almost no change in cardiac output, paralleled by a relevant increase in minute ventilation, tidal volume and respiratory rate. The model can represent a valid tool for clinical practice and medical research, providing an alternative way to experience-based clinical decisions. In conclusion, models are not only capable of summarizing current knowledge, but also identifying missing knowledge. In the former case they can serve as training aids for teaching the operation of complex systems, especially if the model can be used to demonstrate the outcome of experiments. In the latter case they generate experiments to be performed to gather the missing data.

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BACKGROUND: Drugs are routinely combined in anesthesia and pain management to obtain an enhancement of the desired effects. However, a parallel enhancement of the undesired effects might take place as well, resulting in a limited therapeutic usefulness. Therefore, when addressing the question of optimal drug combinations, side effects must be taken into account. METHODS: By extension of a previously published interaction model, the authors propose a method to study drug interactions considering also their side effects. A general outcome parameter identified as patient's well-being is defined by superposition of positive and negative effects. Well-being response surfaces are computed and analyzed for varying drugs pharmacodynamics and interaction types. In particular, the existence of multiple maxima and of optimal drug combinations is investigated for the combination of two drugs. RESULTS: Both drug pharmacodynamics and interaction type affect the well-being surface and the deriving optimal combinations. The effect of the interaction parameters can be explained in terms of synergy and antagonism and remains unchanged for varying pharmacodynamics. For all simulations performed for the combination of two drugs, the presence of more than one maximum was never observed. CONCLUSIONS: The model is consistent with clinical knowledge and supports previously published experimental results on optimal drug combinations. This new framework improves understanding of the characteristics of drug combinations used in clinical practice and can be used in clinical research to identify optimal drug dosing.

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La presente investigación, tiene como objetivo analizar las influencias que ejercen los recursos intangibles (Gestión del Conocimiento, Marca, Reputación Organizacional y Responsabilidad Social) en la gestión estratégica de las instituciones de educación superior (IES) y el impacto de los mismos en los procesos de innovación a través del valor añadido que se transfiere al entorno. Se considera importante realizar un estudio sobre este tema dado que son las IES las encargadas de proporcionar los conocimientos y los nuevos hallazgos en innovaciones tecnológicas, que son transferidas al tejido productivo de las regiones, lo que proporciona crecimiento económico y mejoras en la calidad de vida. El estudio se enmarca dentro de los postulados de la teoría de los recursos y las capacidades (TRC) y de los intangibles, los cuales sirven de base a la investigación. Se planteó un sistema de hipótesis subdividido en dos vías de influencias. La primera, donde se analizan las influencias directas que ejercen los recursos intangibles sobre los resultados de las IES. La otra vía es la indirecta, que estudia las influencias que ejercen los recursos intangibles gestionados estratégicamente sobre los resultados de las IES. Esta investigación se ha concebido como no experimental, de tipo exploratorio, basada en el paradigma que busca explicar un fenómeno (variable dependiente) a través del comportamiento de las variables independientes. Es un estudio transversal, cuantitativo, que intenta describir las causas del fenómeno. Con el objeto de determinar las influencias o relaciones de causalidad que subyacen entre las variables, se utilizó la técnica del modelo de ecuaciones estructurales (SEM). La población objeto de estudio estuvo constituida por los 857 individuos pertenecientes a los consejos directivos de las IES, que forman parte de las base de datos que gestiona el Consorcio de Escuelas de Ingeniería de Latinoamérica y del Caribe y la Universidad Politécnica de Madrid, con un tamaño de muestra significativa de 250 directivos, lo que representa el 29,42% de la población. Como fuentes de recolección de información se utilizaron fuentes primarias y secundarias. Para recabar la información primaria se diseñó un cuestionario (ad hoc), el cual fue validado por expertos. La información de fuentes secundarias se extrajo de la bases de datos de la Red Iberoamericana de Ciencia y Tecnología (RICYT). Los resultados obtenidos indican que las influencias directas que pueden ejercer los recursos intangibles (Gestión del Conocimiento, Marca, Reputación Organizacional y Responsabilidad Social) no son significativas, por ello se rechazaron todas las hipótesis de la vía de influencia directa. Asimismo, de acuerdo con el contraste realizado al submodelo que representa la vía de influencia indirecta, resultaron significativas las influencias que ejercen los intangibles Gestión del Conocimiento y Reputación Organizacional, gestionadas estratégicamente sobre los resultados con valor añadido generado por las IES y transferidos al entorno. Sin embargo, no se apoyan todas las hipótesis del modelo, debido a que los constructos Marca y Responsabilidad Social resultaron no significativos. Las teorías sobre intangibles enmarcadas en la TRC no son del todo robustas y requieren de mayores esfuerzos por parte de los investigadores para lograr definir los constructos a utilizar. De igual forma, se sigue corroborando el desfase que existe entre las teorías que sustentan la investigación y las comprobaciones empíricas de las mismas. Además, se evidencia que las IES enfocan su actuación hacia la academia, por encima de las otras funciones, otorgando a la enseñanza e investigación y a la reputación organizacional una mayor importancia. Sin embargo, debido a su naturaleza no empresarial, las IES siguen manteniendo una filosofía de gestión enfocada a la generación y transmisión de conocimientos que crean reputación. Se excluyen los intangibles Marca y Responsabilidad Social, por considerar que no aportan valor a sus procesos internos o que están inmersos dentro de otros recursos intangibles. En conclusión, se corrobora el atraso de la gestión estratégica que presentan las IES en Latinoamérica. Se comprueba la no aplicación de postulados básicos de la gerencia moderna que contribuyan al manejo eficiente de todos sus recursos y al logro de sus objetivos. Esto deriva en la necesidad de modernizar la visión estratégica de las IES y en crear mejores mecanismos para lograr reconocer, mantener, proteger y desarrollar los Recursos Intangibles que poseen, realizando combinaciones de recursos óptimas, que maximicen la creación de valor para sí mismas y para la sociedad a la que pertenecen. ABSTRACT This research aims to analyze the influences exerted by intangible resources (Knowledge Management, Brand, Organizational Reputation and Social Responsibility) in the strategic management of higher education institutions (HEIs) and their impact in the innovation processes through the added value that is transferred to the environment. It is considered important to conduct a study on this issue since HEIs are responsible for providing knowledge and new findings on technological innovations, which are then, transferred to the productive fabric of these regions, providing economic growth and improvements in quality of life. The study is framed within the tenets of the Theory of Resources and Capabilities (TRC) and of intangibles which underlie this research. A system of hypotheses was raised which was subdivided into two pathways of influences. In the first system the direct influences exerted by intangible resources on the results of the IES are analyzed. The other system focuses on the indirect influences exerted by the strategically managed intangible resources on the HEIs results. This research is designed as experimental, exploratory and based on the paradigm that seeks to explain a phenomenon (the dependent variable) through the behavior of the independent variables. It is a crosssectional, quantitative study, which attempts to describe the causes of the phenomenon. In order to determine the influences or causal relationships among variables the structural equation modeling technique (SEM) was used. The population under study consisted of 857 individuals from the boards of HEIs, which are part of the database managed by the Consortium of Engineering Schools in Latin America and the Caribbean and the Technical University of Madrid, with a significant sample size of 250 managers which represents 29.42% of the population. As sources of information gathering primary and secondary sources were used. To collect primary information an ad-hoc questionnaire which was validated by experts was designed. The secondary information was extracted from the database of the Latin American Network of Science and Technology (RICYT). The results obtained indicate that the direct influences that intangible resources (Knowledge Management, Brand, Organizational Reputation and Social Responsibility) can exert are not significant. Therefore, all hypotheses related to direct influence were rejected. Also, according to the test made with the system which represents the indirect channel of influence, significant influences were exerted on the results with added value generated by the HEIs by the intangibles Knowledge Management and Organizational Reputation when they were managed strategically. However, all model hypotheses are not supported, because the constructs Brand and Social Responsibility were not significant. Theories of intangibles within the framework of the Theory of Resources and Capabilities are not entirely robust and require greater efforts by researchers to define the constructs to be used. Similarly the existing gap between the theories underpinning research and the empirical tests continues to be corroborated. In addition, there is evidence that HEIs focus their action on the academy neglecting the other functions, giving more importance to teaching, research and organizational reputation. However, due to their non-business nature, HEIs still maintain a management philosophy focused on the generation and transmission of knowledge which leads to reputation. The intangibles Brand and Social Responsibility are excluded, considering that they do not add value to their internal processes or are embedded within other intangible resources. In conclusion, the backwardness of HEIs’ strategic management in Latin America is confirmed. The lack of application of the basic principles of modern management that contribute to the efficient administration of all the resources and the achievement of objectives is proven. This leads to the need to modernize the strategic vision of HEIs and the need for better mechanisms to recognize, maintain, protect and develop the intangible resources they possess, achieving optimal combinations of resources in order to maximize the creation of value for them and for the society to which they belong.

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Wide and ‘skip row’ row configurations have been used as a means to improve yield reliability in grain sorghum production. However, there has been little effort put to design of these systems in relation to optimal combinations of root system characteristics and row configuration, largely because little is known about root system characteristics. The studies reported here aimed to determine the potential extent of root system exploration in skip row systems. Field experiments were conducted under rain-out shelters and the extent of water extraction and root system growth measured. One experiment was conducted using widely-spaced twin rows grown in the soil. The other experiment involved the use of specially constructed large root observation chambers for single plants. It was found that the potential extent of root system exploration in sorghum was beyond 2m from the planted rows using conventional hybrids and that root exploration continued during grain filling. Preliminary data suggested that the extent of water extraction throughout this region depended on root length density and the balance between demand for, and supply of, water. The results to date suggest that simultaneous genetic and management manipulation of wide row production systems might lead to more effective and reliable production in specific environments. Further study of variation in root-shoot dynamics and root system characteristics is required to exploit possible opportunities.

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Cross-functional teams play a potentially important part in the innovation process enabling knowledge sharing, the development of trust and overcoming spatial and organizational barriers. Using a supermodularity approach, we focus on potential complementarities which may arise when cross-functional teams are used in different elements of the innovation process in UK and German manufacturing plants. Using optimal combinations of cross-functional teams in the innovation process increases innovation success in the UK by 29.5 per cent compared to 9.5 per cent in Germany. Patterns of complementarity are complex, however, but are more uniform in the UK than in Germany. The most uniform complementarities are between product design and development and production engineering, with little synergy evident between the more technical phases of the innovation process and the development of marketing strategy. In strategic terms, our results suggest the value of using cross-functional teams for the more technical elements of the innovation process but that the development of marketing strategy should remain the domain of specialists.

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Cross-functional teams play a potentially important part in the innovation process enabling knowledge sharing, the development of trust and overcoming spatial and organizational barriers. Using a supermodularity approach, we focus on potential complementarities which may arise when cross-functional teams are used in different elements of the innovation process in UK and German manufacturing plants. Using optimal combinations of cross-functional teams in the innovation process increases innovation success in the UK by 29.5 per cent compared to 9.5 per cent in Germany. Patterns of complementarity are complex, however, but are more uniform in the UK than in Germany. The most uniform complementarities are between product design and development and production engineering, with little synergy evident between the more technical phases of the innovation process and the development of marketing strategy. In strategic terms, our results suggest the value of using cross-functional teams for the more technical elements of the innovation process but that the development of marketing strategy should remain the domain of specialists.

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Drug combinations can improve angiostatic cancer treatment efficacy and enable the reduction of side effects and drug resistance. Combining drugs is non-trivial due to the high number of possibilities. We applied a feedback system control (FSC) technique with a population-based stochastic search algorithm to navigate through the large parametric space of nine angiostatic drugs at four concentrations to identify optimal low-dose drug combinations. This implied an iterative approach of in vitro testing of endothelial cell viability and algorithm-based analysis. The optimal synergistic drug combination, containing erlotinib, BEZ-235 and RAPTA-C, was reached in a small number of iterations. Final drug combinations showed enhanced endothelial cell specificity and synergistically inhibited proliferation (p < 0.001), but not migration of endothelial cells, and forced enhanced numbers of endothelial cells to undergo apoptosis (p < 0.01). Successful translation of this drug combination was achieved in two preclinical in vivo tumor models. Tumor growth was inhibited synergistically and significantly (p < 0.05 and p < 0.01, respectively) using reduced drug doses as compared to optimal single-drug concentrations. At the applied conditions, single-drug monotherapies had no or negligible activity in these models. We suggest that FSC can be used for rapid identification of effective, reduced dose, multi-drug combinations for the treatment of cancer and other diseases.

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OBJECTIVES The aim of this study was to optimise dexmedetomidine and alfaxalone dosing, for intramuscular administration with butorphanol, to perform minor surgeries in cats. METHODS Initially, cats were assigned to one of five groups, each composed of six animals and receiving, in addition to 0.3 mg/kg butorphanol intramuscularly, one of the following: (A) 0.005 mg/kg dexmedetomidine, 2 mg/kg alfaxalone; (B) 0.008 mg/kg dexmedetomidine, 1.5 mg/kg alfaxalone; (C) 0.012 mg/kg dexmedetomidine, 1 mg/kg alfaxalone; (D) 0.005 mg/kg dexmedetomidine, 1 mg/kg alfaxalone; and (E) 0.012 mg/kg dexmedetomidine, 2 mg/kg alfaxalone. Thereafter, a modified 'direct search' method, conducted in a stepwise manner, was used to optimise drug dosing. The quality of anaesthesia was evaluated on the basis of composite scores (one for anaesthesia and one for recovery), visual analogue scales and the propofol requirement to suppress spontaneous movements. The medians or means of these variables were used to rank the treatments; 'unsatisfactory' and 'promising' combinations were identified to calculate, through the equation first described by Berenbaum in 1990, new dexmedetomidine and alfaxalone doses to be tested in the next step. At each step, five combinations (one new plus the best previous four) were tested. RESULTS None of the tested combinations resulted in adverse effects. Four steps and 120 animals were necessary to identify the optimal drug combination (0.014 mg/kg dexmedetomidine, 2.5 mg/kg alfaxalone and 0.3 mg/kg butorphanol). CONCLUSIONS AND RELEVANCE The investigated drug mixture, at the doses found with the optimisation method, is suitable for cats undergoing minor clinical procedures.

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Nowadays, the rising competition for the use of water and environmental resources with consequent restrictions for farmers should change the paradigm in terms of irrigation concepts, or rather, in order to attain economical efficiency other than to supply water requirement for the crop. Therefore, taking into account the social and economical role of bean activity in Brazil, as well as the risk inherent to crop due to its high sensibility to both deficit and excessive water, the optimization methods regarding to irrigation management have become more interesting and essential. This study intends to present a way to determine the optimal water supply, considering different combinations between desired bean yield and level of risk, bringing as a result a graph with the former associated with the latter, depending on different water depths.

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The paper proposes an approach aimed at detecting optimal model parameter combinations to achieve the most representative description of uncertainty in the model performance. A classification problem is posed to find the regions of good fitting models according to the values of a cost function. Support Vector Machine (SVM) classification in the parameter space is applied to decide if a forward model simulation is to be computed for a particular generated model. SVM is particularly designed to tackle classification problems in high-dimensional space in a non-parametric and non-linear way. SVM decision boundaries determine the regions that are subject to the largest uncertainty in the cost function classification, and, therefore, provide guidelines for further iterative exploration of the model space. The proposed approach is illustrated by a synthetic example of fluid flow through porous media, which features highly variable response due to the parameter values' combination.